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DESTIN, FLA. — The fact that some patients have antiphospholipid antibodies for years and only develop clinical problems under certain conditions has given rise to the theory that a “second hit” is sometimes required to trigger antiphospholipid syndrome, Dr. Ann Parke said at the annual Rheumatology on the Beach.
Second hit phenomena include pregnancy, exogenous estrogens, flares of systemic lupus erythematosus (SLE), infection and inflammation, surgery, and vascular procedures or trauma. All may promote thrombosis in these patients, said Dr. Park, professor of medicine at the University of Connecticut, Farmington. These conditions and circumstances interfere with normal anticoagulant pathways, in particular the protein C and S pathways known to be associated with antiphospholipid syndrome (APS). Patients with antiphospholipid antibodies should notify physicians if they become pregnant or if they are to undergo surgery or vascular procedures.
Those undergoing surgery must be adequately anticoagulated perioperatively and maintained on low-molecular-weight heparin as necessary. In those with SLE, flares should be controlled and monitored.
It is also important that patients with antiphospholipid antibodies be warned of risks associated with use of exogenous estrogens, Dr. Park said.
Infection is the most worrisome of the second hit factors, because it is the least controllable. Patient education about preventing infection is critical, she said.
DESTIN, FLA. — The fact that some patients have antiphospholipid antibodies for years and only develop clinical problems under certain conditions has given rise to the theory that a “second hit” is sometimes required to trigger antiphospholipid syndrome, Dr. Ann Parke said at the annual Rheumatology on the Beach.
Second hit phenomena include pregnancy, exogenous estrogens, flares of systemic lupus erythematosus (SLE), infection and inflammation, surgery, and vascular procedures or trauma. All may promote thrombosis in these patients, said Dr. Park, professor of medicine at the University of Connecticut, Farmington. These conditions and circumstances interfere with normal anticoagulant pathways, in particular the protein C and S pathways known to be associated with antiphospholipid syndrome (APS). Patients with antiphospholipid antibodies should notify physicians if they become pregnant or if they are to undergo surgery or vascular procedures.
Those undergoing surgery must be adequately anticoagulated perioperatively and maintained on low-molecular-weight heparin as necessary. In those with SLE, flares should be controlled and monitored.
It is also important that patients with antiphospholipid antibodies be warned of risks associated with use of exogenous estrogens, Dr. Park said.
Infection is the most worrisome of the second hit factors, because it is the least controllable. Patient education about preventing infection is critical, she said.
DESTIN, FLA. — The fact that some patients have antiphospholipid antibodies for years and only develop clinical problems under certain conditions has given rise to the theory that a “second hit” is sometimes required to trigger antiphospholipid syndrome, Dr. Ann Parke said at the annual Rheumatology on the Beach.
Second hit phenomena include pregnancy, exogenous estrogens, flares of systemic lupus erythematosus (SLE), infection and inflammation, surgery, and vascular procedures or trauma. All may promote thrombosis in these patients, said Dr. Park, professor of medicine at the University of Connecticut, Farmington. These conditions and circumstances interfere with normal anticoagulant pathways, in particular the protein C and S pathways known to be associated with antiphospholipid syndrome (APS). Patients with antiphospholipid antibodies should notify physicians if they become pregnant or if they are to undergo surgery or vascular procedures.
Those undergoing surgery must be adequately anticoagulated perioperatively and maintained on low-molecular-weight heparin as necessary. In those with SLE, flares should be controlled and monitored.
It is also important that patients with antiphospholipid antibodies be warned of risks associated with use of exogenous estrogens, Dr. Park said.
Infection is the most worrisome of the second hit factors, because it is the least controllable. Patient education about preventing infection is critical, she said.